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Original Article
Characteristics of Peripheral Polyneuropathy after Chemotherapy in Pediatric Acute Lymphoblastic Leukemia
Clin Pediatr Hematol Oncol 2017;24:107-13.
Published online October 31, 2017
© 2017 Korean Society of Pediatric Hematology-Oncology and Korean Society for Pediatric Neuro-Oncology

Yu-Sun Min, M.D.1, Min-Gu Kang, M.D.1 and Ji Yoon Kim, M.D.2

Departments of 1Rehabilitation, 2Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
Correspondence to: Ji Yoon Kim
Department of Pediatric Hematology-Oncology, Kyungpook National University Children’s Hospital, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Buk-gu, Daegu 41404, Korea
Tel: +82-53-200-5704 Fax: +82-53-425-6683 E-mail:
Received September 18, 2017; Revised October 8, 2017; Accepted October 18, 2017.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Vincristine is an antimitotic agent used for treatment of leukemia, lymphomas, and cancers. Its main side effect is a dose-related, length-dependent axonal neuropathy. Methods: We performed electrodiagnostic examinations in 18 children who had been treated with vincristine and who presented with the clinical picture of a peripheral neuropathy.Results: The mean cumulative dose of vincristine was 37.7±26.5 mg/m2. Electrodiagnostic examination showed an axonal neuropathy with a length-dependent pattern. All patients showed motor nerve abnormalities and sensory nerve abnormalities were observed in 13 patients (72.2%). The number of affected nerves was 2.67±1.1 (mean±SD) of four motor nerves and 1.5±1.4 of four sensory nerves. The mean reduction of the compound muscle action potential amplitude was 70.9±42.2% in the median nerve and 23.7±20.8% in the peroneal nerve compared to normal value. However, the mean change in the sensory nerve action potential amplitude was 139.9±78.5% in the median nerve and 246.9±169.7% in the superficial peroneal nerve. There was statistically significant difference between amplitude reduction of the compound muscle action potential and sensory nerve action potential.Conclusion: The quantitative analysis of electrophysiological motor predominance described differs from the mainly sensory neuropathy reported in adults. Incomplete myelination in motor nerve due to young age may have resulted in greater sensitivity of some nerves to neurotoxic agents.
Keywords: Vincristine, Polyneuropathy, Pediatrics, Leukemia, Chemotherapy
  1. Mora E, Smith EM, Donohoe C, Hertz DL. Vincristine-induced peripheral neuropathy in pediatric cancer patients. Am J Cancer Res 2016;6:2416-30.
    Pubmed KoreaMed
  2. Vainionpää L, Kovala T, Tolonen U, Lanning M. Vincristine therapy for children with acute lymphoblastic leukemia impairs conduction in the entire peripheral nerve. Pediatr Neurol 1995;13:314-8.
  3. Tay CG, Lee VWM, Ong LC, Goh KJ, Ariffin H, Fong CY. Vincristine-induced peripheral neuropathy in survivors of childhood acute lymphoblastic leukaemia. Pediatr Blood Cancer 2017;64.
  4. Jain P, Gulati S, Seth R, Bakhshi S, Toteja GS, Pandey RM. Vincristine-induced neuropathy in childhood ALL (acute lymphoblastic leukemia) survivors: prevalence and electrophysiological characteristics. J Child Neurol 2014;29:932-7.
    Pubmed CrossRef
  5. Courtemanche H, Magot A, Ollivier Y, et al. Vincristine-induced neuropathy: Atypical electrophysiological patterns in children. Muscle Nerve 2015;52:981-5.
    Pubmed CrossRef
  6. Reinders-Messelink HA, Van Weerden TW, Fock JM, et al. Mild axonal neuropathy of children during treatment for acute lymphoblastic leukaemia. Eur J Paediatr Neurol 2000;4:225-33.
    Pubmed CrossRef
  7. Yildiz FG, Temucin ÇM. Vincristine-induced neurotoxicity: electrophysiological features in children. Neurol Res 2016;38: 124-9.
    Pubmed CrossRef
  8. Preston DC, Shapiro BE. Electromyography and neuromuscular disorders: clinical-electrophysiologic correlations. 3rd ed. Philadelphia: Elsevier, 2012.
  9. Seibel NL, Steinherz PG, Sather HN, et al. Early postinduction intensification therapy improves survival for children and adolescents with high-risk acute lymphoblastic leukemia: a report from the Children's Oncology Group. Blood 2008;111: 2548-55.
    Pubmed KoreaMed CrossRef
  10. Maloney KW, Devidas M, Mattano LA Jr, et al. Excellent event free (EFS) and overall survival (OS) for children with standard risk acute lymphoblastic leukemia (SR ALL) despite the absence of a significant impact on outcome with the addition of an intensified consolidation: Results of Children’s Oncology Group (COG) AALL0331. Blood 2013;122:837.
  11. Mattano LA Jr, Devidas M, Winick N, et al. Effects of dexamethasone (DEX) vs prednisone (PDN) and high-dose methotrexate (HD-MTX) vs capizzi methotrexate/asparaginase (C-MTX/ASNase) on osteonecrosis (ON) incidence in children and young adults with high risk acute lymphoblastic leukemia (HR-ALL): A report from the Children's Oncology Group (COG) study AALL0232. Blood (54th ASH Annual Meeting) 2012;120:665.
  12. Lobert S, Vulevic B, Correia JJ. Interaction of vinca alkaloids with tubulin: a comparison of vinblastine, vincristine, and vinorelbine. Biochemistry 1996;35:6806-14.
    Pubmed CrossRef
  13. LaPointe NE, Morfini G, Brady ST, Feinstein SC, Wilson L, Jordan MA. Effects of eribulin, vincristine, paclitaxel and ixabepilone on fast axonal transport and kinesin-1 driven microtubule gliding: implications for chemotherapy-induced peripheral neuropathy. Neurotoxicology 2013;37:231-9.
    Pubmed KoreaMed CrossRef
  14. Kiguchi N, Maeda T, Kobayashi Y, Saika F, Kishioka S. Involvement of inflammatory mediators in neuropathic pain caused by vincristine. Int Rev Neurobiol 2009;85:179-90.
  15. Argyriou AA, Bruna J, Marmiroli P, Cavaletti G. Chemotherapy- induced peripheral neurotoxicity (CIPN): an update. Crit Rev Oncol Hematol 2012;82:51-77.
    Pubmed CrossRef
  16. Ino D, Iino M. Schwann cell mitochondria as key regulators in the development and maintenance of peripheral nerve axons. Cell Mol Life Sci 2017;74:827-35.
    Pubmed CrossRef
  17. Ibáñez CF, Ernfors P. Hierarchical control of sensory neuron development by neurotrophic factors. Neuron 2007;54:673-5.
    Pubmed CrossRef
  18. Wang F, Zhou F, Kruh GD, Gallo JM. Influence of blood- brain barrier efflux pumps on the distribution of vincristine in brain and brain tumors. Neuro Oncol 2010;12:1043-9.
    Pubmed KoreaMed CrossRef
  19. Quasthoff S, Hartung HP. Chemotherapy-induced peripheral neuropathy. J Neurol 2002;249:9-17.
    Pubmed CrossRef
  20. Kaji R, Nodera H. Who is the primary suspect in acute motor axonal neuropathy? Muscle Nerve 2003;28:657-8.
    Pubmed CrossRef
  21. Chan JD. Pharmacokinetic drug interactions of vinca alkaloids: summary of case reports. Pharmacotherapy 1998;18:1304-7.
  22. Ozyurek H, Turker H, Akbalik M, Bayrak AO, Ince H, Duru F. Pyridoxine and pyridostigmine treatment in vincristine- induced neuropathy. Pediatr Hematol Oncol 2007;24:447-52.
    Pubmed CrossRef
  23. Starobova H, Vetter I. Pathophysiology of chemotherapy- induced peripheral neuropathy. Front Mol Neurosci 2017; 10:174.
    Pubmed KoreaMed CrossRef
  24. Yoo SW, Shin HK, Yeo MS, et al. Prevalence of late effects by designed health promotion program in long-term survivors of childhood cancer. Clin Pediatr Hematol Oncol 2012; 19:31-9.
  25. Cavaletti G, Marmiroli P. Chemotherapy-induced peripheral neurotoxicity. Nat Rev Neurol 2010;6:657-66.
    Pubmed CrossRef
  26. Franssen H, van den Bergh PY. Nerve conduction studies in polyneuropathy: practical physiology and patterns of abnormality. Acta Neurol Belg 2006;106:73-81.

October 2018, 25 (2)
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  • Ji Yoon Kim